TFIA’s Private Market Flood program offers FOUR solutions to ever-increasing annual flood insurance premiums: Rate-Lock allows you to pay the same rate for two years with one year rate lock or three years with two year Rate-Lock (Premium is paid annually). Additionally, Pre-Pay in full for a two year policy guaranteeing no increase for the second year of the policy or Pre-Pay three years premium guaranteeing no increase for three years.

Purchase Requirement *

Loan Closing

Expiring FEMA Policy

Lapsed FEMA Flood Policy

Other-14 Day Waiting Period

Requested Effective Date *

Requested Effective Date

Cannot be more than 60 days from date of application. Required waiting period is 14 days unless the date of a loan closing is sooner, you have an active FEMA policy, or a FEMA policy unpaid renewal is within the 30 day grace period. (to maintain prior expiration date requires a “no known loss” letter, click here). NO COVERAGE IS BOUND UNTIL THE APPLICATION IS APPROVED BY UNDERWRITER AND THE FULL ANNUAL PREMIUM IS RECEIVED.

MM

DD

YYYY

Insured First Name *

Insured Last Name *

2nd Insured First Name

2nd Insured Last Name

Property Location *

Each structure requires a separate application other than a detached residential garage used only as a garage.

City *

State *

Zip Code *

County in Which Located *

Mailing Address (if different than property)

Mailing Address City

Mailing Address State

Mailing Address Zip Code

Phone *

Phone

Property Owner Phone Numbers (not insurance agent’s phone number)

(###)

###

####

Cell Phone

Cell Phone

(###)

###

####

Contact Email *

This is the email address the underwriter will use to respond to your application.

ONCE YOUR LENDER PAYS YOUR RENEWAL PREMIUM YOU CANNOT CANCEL THE FEMA POLICY****TO PREVENT YOUR LENDER FROM PAYING A RENEWAL PREMIUM YOU DO NOT WANT THEM TO PAY YOU MUST NON-RENEW YOUR FEMA POLICY(ask us for details).

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DD

YYYY

Primary Residence *

Owner lives in at least 250 days per year

Yes

No

NFIP Flood Zone *

This information can be found on: your present FEMA policy, a flood zone determination from your lender, an appraisal, or an elevation certificate. Your city or county building department may be able to provide you with this information as well. If flood insurance is required by a lender 99% of the time the flood zone will be an “A”. If the structure is within one mile of the Atlantic or Pacific Ocean or the Gulf of Mexico it is possible the flood zone will be a “V”. Our underwriters will verify the flood zone you enter when we receive your application and inform you if it is different than what you entered.

Date of Construction *

Date of Construction

MM

DD

YYYY

Number of Floors *

One Floor

Two Floors

Three or More Floors

Occupancy *

Check all that apply

Residential Single Family

Two to Four Unit Building

Detached Garage

Attached Garage

Foundation Type *

Slab

Basement including walkout types

Crawlspace

Other Enclosure

First Mortgagee Name

If applicable

First Mortgagee Address

First Mortgagee City

First Mortgagee State

First Mortgagee Zip Code

First Mortgagee Loan Number

Second Mortgagee Name

If applicable

Second Mortgagee Address

Second Mortgagee City

Second Mortgagee State

Second Mortgagee Zip Code

Second Mortgagee Loan Number

Acknowledgement of Potential loss of fema subsidy

In 2014, Congress enacted the Homeowner Flood Insurance Affordability Act, which authorizes the National Flood Insurance Program (NFIP) to make a lower cost flood insurance rating option (known as grandfathering) available to property owners who have participated in the NFIP by maintaining continuous, uninterrupted coverage through NFIP. If you intentionally allow your NFIP policy to lapse and later choose to repurchase a NFIP policy, it is possible that FEMA may apply the full risk rate -- and not the grandfathered lower cost rate -- for flood insurance for this property. Applicant hereby understands and acknowledges that if continuous coverage is not maintained with NFIP, then the subject property might no longer be eligible for a grandfathering discount, and the full risk rate may apply, if at some later date insurance applicant seeks to obtain coverage from the NFIP. *

Yes

acknowledgement of availability of coverage

Applicant attests that they are aware that personal property coverage of up to $250,000 is available and excess flood insurance over $250,000 is available and requires a separate application. *

Yes

Applicant attests that they are aware that flood insurance building coverage is available up to $500,000 and excess flood insurance over $500,000 is available and requires a separate application. *

Yes

loss record

Applicant attests that they are not aware of more than one flood loss within the past five years, unrepaired damage from a flood, a flood loss to the structure of $250,000 or greater, or that the property has been designated by FEMA as a Severe Repetitive Loss property. *

Yes

No

Applicant attests that they are aware that quoted premiums for properties with more than one flood loss within the past five years, properties with unrepaired damage from a flood, properties that incurred a flood loss to the structure of $250,000 or greater and any property that has been designated by FEMA as a Severe Repetitive Loss property are double those premiums quoted for properties without such losses and the policy, if issued, contains provisions for reduction and reformation of coverage if prior flood damage is discovered that has not been disclosed *

Yes

No

Ineligible properties

Applicant attests that the building for which coverage is requested is NOT a Mobile Home, Condominium Unit, or Commercial Building. The building does not reside in an NFIP community under NFIP probation. Nor has the property been designated by a duly constituted State or local authority to be in violation of State or local floodplain management regulates (Section 1316). *

Yes

No

Payor of INITIAL policy term *

Who will be paying for this year's policy?

Insured

Lender

Comments and/or Any Additional Information:

Thank you! An underwriter will review your application shortly and respond to you within one business day. If you have an immediate need that requires a response sooner, please call us at 877-356-6348. We look forward to assisting you.

An underwriter will review your application the same or the next business day and, if approved, will email you an approved application for you to sign along with instructions on how to remit payment. This Application will be attached to and form a part of any Certificate and/or Policy that may be issued with certain UNDERWRITERS AT LLOYD’S OF LONDON or LEXINGTON INSURANCE COMPANY. TFIA will determine whether to offer you a Lloyd's policy or a Lexington policy based on various underwriting criteria. If you have a strong preference which company you prefer, you may indicate so in the "comments" field above, however we may not be able to accommodate your request.